This page is a good place to start for someone who has limited time and who is looking for a brief overview of the issue.
This fact sheet briefly sums up the iatrogenic (medically induced) benzodiazepine problem. It includes facts which present the problem (as well as hyperlinks to more detailed information on each topic) as well as a bullet-pointed list of how the medical community is perpetuating the problem.
- Benzodiazepines (BZs) are the most widely prescribed drugs in the world for anxiety, stress, and sleep. They are also prescribed for depression (see point 16 below), pain, muscle relaxation and much-much more.
- The Committee on Safety of Medicines and the Royal College of Psychiatrists in the UK concluded in various statements (1988 and 1992) that benzodiazepines are unsuitable for long-term use and that they should, in general, be prescribed for periods of 2-4 weeks only.
- The evidence suggests that benzodiazepines are no longer effective after a few weeks or months of regular use (due to Tolerance), so when prescribed for regular use beyond this, the risks can outweigh any potential benefits.
- Experts say BZs can be “more addictive than heroin”. Prescribing beyond the recommended period can result in doctor induced physical dependence and associated withdrawal syndromes.
- Withdrawal can be like hell lasting for months, or even many years (see: protracted withdrawal syndrome).
- When tolerance develops, “withdrawal” symptoms can appear even though the BZ patient continues to take the drug at the same dose. In fact, it is because the patient didn’t increase the dose that tolerance develops. Thus the symptoms suffered by many long-term users are a mixture of adverse effects of the drugs and “withdrawal” effects due to tolerance (See The Ashton Manual).
- Tolerance doesn’t always develop across all symptoms. Someone might develop tolerance to the hypnotic (promotion of sleep) effects but not to the anxiolytic (anxiety relief) effects.
- Tolerance to the various actions of benzodiazepines develops at variable rates and to different degrees (See The Ashton Manual).
- There is no “low dose” that is immune to the problems seen in the larger doses. For example, tolerance, physical dependence, and/or withdrawal/protracted withdrawal have been observed after the regular use of 2.5-5mg of diazepam.
- Withdrawal is different for each individual and depends on many individual factors. For some it is severe and can persist for many years. Over-rapidly tapering or cold-turkey increases the risk for more severe and long-lasting withdrawal.
- During tolerance and withdrawal, benzodiazepine patients report the appearance of totally new symptoms (sometimes in addition to the original symptoms for which the drug was prescribed) that were not present before the benzodiazepine “treatment” began (See The Ashton Manual. Also see how to identify tolerance and how to differentiate withdrawal symptoms from original symptoms).
- Withdrawal is not a smooth consistent process. Symptoms characteristically wax and wane (and sometimes for a long time), varying in severity and type with wave-like recurrences (See The Ashton Manual).
- BZs have different potencies which is important to consider when switching from one benzodiazepine to another, reducing etc.
- BZs don’t mix well with other nervous system depressant drugs (e.g., opiates), substances, alcohol etc. They have additive effects which can be lethal. They can also potentiate the effects of some drugs. As Boston Medical Center epidemiologist, Traci Green, stated: “One opioid plus one benzo doesn’t equal the effect of two in the individual…It’s like one plus one equals four or six.” (See article). For more on BZs and other medications, go here.
- Fluoroquinolone antibiotics can sometimes aggravate withdrawal symptoms and the quinolones actually displace BZs from their binding sites on GABA-receptors. As a result, these antibiotics can precipitate acute withdrawal in people taking or tapering benzodiazepines (See The Ashton Manual).
- In 1988 the Committee on Safety of Medicines in the UK recommended that “benzodiazepines should not be used alone to treat depression or anxiety associated with depression. Suicide may be precipitated in such patients”.
- Depressive symptoms are common both during long-term benzodiazepine use and in withdrawal, as benzodiazepines are central nervous system depressants (antidepressants also have problems).
- Recent studies associate prolonged BZ use with irreversible damages. (See: The Ashton Manual Supplement).
- Repeated (and incorrect, e.g., cold-turkey and/or over-rapid) withdrawals can result in kindling, making each successive attempt more difficult, so a slow appropriate withdrawal from the outset is very important.
- It is not unusual to experience flashbacks and recurrences (called “setbacks”) of apparent benzodiazepine withdrawal symptoms years after a successful withdrawal and a return to normal health.
- Socioeconomic costs include unemployment, violent crime, suicides, frequent hospital visits, domestic disharmony, accidents and much-much more.
- Experts have been lobbying governments for decades for stricter controls, but to no avail.
- There are an estimated 1.5 million people suffering from doctor induced BZ drug dependency in England alone (with prescribed antidepressants now also a major problem) − the number worldwide must be staggering.
- It is dangerous to abruptly stop or quickly reduce these drugs. They must be slowly tapered.
- Anyone thinking about stopping should initially consult The Ashton Manual and their doctor. Beware that doctors may know very little at best, but their cooperation may be necessary. Please show them The Ashton Manual after reading it yourself. One may also consider consulting the W-BAD Resources Page for more tapering information and help.
Also, consider this excerpt from The Ashton Manual:
Facilities for benzodiazepine dependent people need to be developed. Detoxification units which deal with dependence on alcohol and illicit drugs are not appropriate for prescribed benzodiazepine users who have unwittingly become physically dependent through no fault of their own[, simply by way of being a compliant patient.]
Such places usually withdraw the drugs too rapidly and apply rigid “contract” rules which are quite unsuitable for benzodiazepine patients struggling with withdrawal symptoms. [These places also follow an “addiction model” of recovery which focuses on the behavior of abuse and misuse, which is totally irrelevant and inappropriate for an iatrogenically physically dependent benzodiazepine patient.]
Much needed are clinics specialising in benzodiazepine withdrawal where clients can receive individualised, flexible, understanding and supportive counselling.
The first night Luke checked in, staff at the clinic took his clonazepam away.
Professor Malcolm Lader, professor of clinical psychopharmacology and benzodiazepine expert out of the UK, also speaks to the lack of facilities for iatrogenic benzodiazepine dependence:
It’s very difficult to come off these drugs and the facilities are just not available and the great scandal is that the NHS claims to be dealing with these people by referring them to addiction centres, where essentially they’ll sit next to a street user who’s injecting heroine and of course a housewife who’s been put on tranquillisers by her doctor is very upset by this … There is a change taking place which is that if a general practitioner prescribes for longer than the agreed time – two weeks or four weeks – they can be sued by the patient for substandard clinical care and I suspect in the longer term the prescribing of these drugs will be as much dependent on lawyers’ attitudes as it will be on doctors’ attitudes.
Despite the above facts, countless ill-informed healthcare providers worldwide are:
- Prescribing without giving proper informed consent to their patients about the risks/dangers of use past 2-4 weeks time.
- Prescribing without conducting a thorough risk versus benefit analysis.
- Prescribing without firstly exploring non-drug options.
- Prescribing for off-label uses without understanding the risks or informing patients of the risks.
- Prescribing well beyond the recommended 2-4 week prescribing period, which in many cases, is resulting in iatrogenic physical dependence.
- Poly-drugging (prescribing more than one drug simultaneously), not understanding that benzodiazepines have additive effects with other drugs, substances, and alcohol, which can cause severe adverse effects and even death.
- Unaware of just how highly dependence-forming these drugs actually are with use past 2-4 weeks time (sometimes the physical dependence forms quickly, in just a few weeks time with daily prescribed use).
- Unaware that withdrawal symptoms can occur during the treatment, whilst still taking the same dose, due to tolerance (This is often misdiagnosed as a worsening of the patient’s original condition or the development of another illness; resulting in the prescribing of yet more drugs and an overall compounding the problem).
- Unaware that withdrawal symptoms can last for months and often many years (protracted withdrawal syndrome). This too leads to misdiagnosing and the prescribing of yet more drugs, adding to the suffering of individuals.
- Unaware that BZs can cause the very symptoms they are intended to treat and withdrawal symptoms generally tend to consist of a mirror image of the drugs’ initial effects.
- Unaware that these drugs have horrendous withdrawal symptoms and need to be tapered slowly taking into consideration individual factors and the potencies of different benzodiazepines.
- Prescribing benzodiazepines to former addicts, which is contraindicated.
- Prescribing benzodiazepines for PTSD, which is also contraindicated.
- Unaware of the intense suffering and harms caused to unsuspecting individuals, the effects on their families, jobs and indeed all society.
- Unaware of the stigma attached to suffering from an involuntary drug dependency (doctor induced drug damages) which is made worse by misrepresentations in a lot of media reports. Many media use sensationalistic titles which falsely put blame on the patients (the victims) by inaccurately labelling the problem “addiction” when this occurs with regular prescribed use, absent abuse.
- Also consider: Many people who have been rendered dependent by their doctors (suffering from iatrogenic drug damages) are very afraid and are suffering alone in the dark. They have lost faith in medical systems which are centered on prescribing dangerous chemical drugs as the first line of treatment. Many people are desperate and have nowhere to turn. Many are committing suicide.